Women with a fear of childbirth endure a longer labor, finds new research

Between 5 and 20% of pregnant women have a fear of childbirth. Various factors have been associated with increased prevalence of fear of childbirth, including young maternal age, being a first-time mother, pre-existing psychological problems, lack of social support and a history of abuse or adverse obstetric events.

This Norwegian study looked at 2206 women with a singleton pregnancy who intended to deliver vaginally.

Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ), a validated psychometric instrument designed to measure fear of childbirth. Women undertook the questionnaire at 32 weeks gestation and fear of childbirth was defined as a score of more than 85. Out of the total number, 165 (7.5%) women scored more than 85.

Labour duration was defined as 3-4 centimetres cervical dilatation and 3 uterine contractions per 10 minutes, until delivery of the child.

The average age of the participants at delivery was 30.9 years and 50.5% (1113 women) were first time mothers. Average labour duration was 8.22 hours for first-time mothers, and it was 4.91 hours for parous women.

The researchers found that women with a fear of childbirth spent one hour and 32 minutes longer in labour than women with no such fear. After adjustment for other factors associated with labour duration, such as parity, epidural analgesia, instrumental vaginal delivery and labour induction, the difference was still significant at 47 minutes.

Average labour duration was 8 hours for women with fear of childbirth compared to 6.46 hours (which equals 6 hours and 28 minutes) for women without fear.

The study also found that women with fear of childbirth more often delivered by instrumental vaginal delivery (17.0% versus 10.6%) or emergency caesarean delivery (10.9% versus 6.8%) as compared to women without fear of childbirth.

In total, 25.5% (42 women) of women with fear of childbirth and 44.4% (906 women) of women without fear of childbirth had a vaginal delivery without any obstetric interventions.

However, despite increased labour duration for women with a fear of childbirth, a large proportion of women achieved a vaginal delivery which was their intention compared to women with no fear (89.1% versus 93.2%).

Samantha Salvesen Adams, Health Services Research Centre, Akershus University Hospital, University of Oslo, Norway and co-author of the research said:

"Fear of childbirth seems to be an increasingly important issue in obstetric care. Our finding of longer duration of labour in women who fear childbirth is a new piece in the puzzle within this intersection between psychology and obstetrics.

"We found a link between fear of childbirth and longer duration of labour. Generally, longer labour duration increases the risk of instrumental vaginal delivery and emergency caesarean section. However, it is important to note that a large proportion of women with a fear of childbirth successfully had a vaginal delivery and therefore elective caesarean delivery should not be routinely recommended."

John Thorp, BJOG Deputy-Editor-in-Chief added:

"There are a number of reasons why women may develop a fear of childbirth. This research shows that women with fear of childbirth are more likely to need obstetric intervention and this needs to be explored further so that obstetricians and midwives can provide the appropriate support and advice."